Endoscopic surgery, including procedures performed by way of endoscopic instruments such as gastroscopes, colonoscopes, laparoscopes, and the like, may be preferred as an alternative to open surgery due to the many advantages attributed to such “minimally invasive” techniques, such as shortened hospital stays, reduced recovery time, reduced risk of complications, and diminishment of the amount of and/or visibility of scarring caused by a surgical intervention. In many endoscopic procedures, as in open surgery, there are instances where a surgeon may desire to repair damaged or diseased tissues by apposing the tissues together using a suture. However, the suturing devices, stapling devices, and other fastener applicators that have been developed to aid surgeons performing open surgery generally cannot be easily redesigned to be passed through a flexible endoscopic instrument, which may have a working channel having an internal diameter in the range of about 2.0 to 4.0 millimeters (mm). In addition, surgeons performing endoscopic procedures generally cannot simultaneously manipulate multiple devices fed through such working channels with sufficient ease to permit them to routinely emulate the “pass and catch” suturing techniques that may be employed in open surgery.
To address these problems, various suture anchors and applicator devices have been developed to permit surgeons to endoscopically emplace sutures within tissues. Such suture anchors may be deployed using applicator devices that are inserted within and extended through the working channel of an endoscope, carrying a suture anchor to the site of repair. The applicators typically include a cannulated needle portion which permits the surgeon to penetrate the tissues adjacent to diseased or damaged tissue and to deploy the suture anchor into the tissue to be apposed in a repair. The suture anchor is generally attached to a distal end of a suture, with the bulk of the suture extending alongside or within a portion of the applicator device and with a proximal end of the suture trailing outside the endoscopic instrument. The surgeon may deploy multiple suture anchors around the site of repair by serially passing multiple applicators through a flexible endoscope to the site of repair, or by repeatedly passing and withdrawing a single applicator that may be serially reloaded with additional suture anchors. After deploying the suture anchors, the surgeon may appose the tissue by applying traction to the proximal ends of the sutures and securing the sutures using at least one additional surgical device such as a grasper or a knot pusher device. The repeated insertion of each suture anchor and/or the repeated insertion, operation, and withdrawal of one or more endoscopic devices can increase the complexity of the endoscopic procedure as well as the complexity of equipment inventory and management within the operating environment.
Accordingly, there remains a need for methods and devices for deploying and securing multiple suture anchors.